Representatives from ministries of health and finance, purchasing agencies, parliaments and local authorities in 11 countries benefitted from the first Russian-language version of the WHO Barcelona Course on Health Financing for Universal Health Coverage conducted recently in Issyk-Kul, Kyrgyzstan.

The week-long intensive course during 24-28 July 2017 was attended by 52 participants. The course was offered by the WHO headquarters and the Regional Office for Europe in collaboration with the UHC Partnership. The partnership is funded by the European Union, Grand Duchy of Luxembourg and -WHO.

The course had a strong emphasis on the post-Soviet legacy in organization of the health-care system. Participants also extensively discussed experiences and lessons from countries implementing health financing reforms over the past 25 years.

“Countries of former Soviet Union have a specific history that is a bit different than other countries around the world in terms of moving towards UHC. In particular, until 1990 all countries had so called universal health systems, so everyone had a reasonable expectation to get health care when needed. But in 1990 we saw a gap between what was officially promised and a reality of, for instance, absence of medicines and supplies in health facilities. So in this region this gap led to a very strong emphasis on improving efficiency as a key strategy for moving towards UHC, and this is one of the topics we discussed deeply during the course. I believe it was also very important to allow cross-learning of countries in addressing this and other challenges on their path towards UHC,” said Joseph Kutzin, Coordinator for Health Financing Policy, WHO.

The participants from 11 countries – comprising Armenia, Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, Latvia, the Republic of Moldova, the Russian Federation, Tajikistan, Ukraine and Uzbekistan – gathered to develop their expertise in the area of health financing and UHC. The course combined lectures, group work, intense home tasks and simulation exercises.

“It is very important that we have this course now in Russian language. In this part of the world UHC is very important, since out-of-pocket payments are high and our new study shows that catastrophic expenditures are prevalent. Move towards UHC is in the agenda of all of the participating countries, but there is no training in Russian language on health system strengthening and on health financing. So we decided to bring this training here at the time when countries are carrying out health financing and health system reforms, and when the capacity needs to be further increased,” said course director Dr Melitta Jakab, Senior Health Economist, WHO/Europe.

The course was built around detailed discussion on key health financing functions – raising revenues, pooling of health resources, purchasing and designing a benefit package – as well as on governance in health financing and overall alignment of reforms in the health-care sector.

Participants were introduced to the methodology of deep situation analysis, and were advised to frame future reforms based on the local context and existing challenges. Participants also explored how to align policy instruments with policy objectives.

Gathering perspectives through broad stakeholder participation

The participation of different government entities and the different roles of participants in implementation of health financing reforms ensured that a variety of perspectives were voiced in the discussions. For instance, insights were gained from different professional backgrounds on the issues of fiscal constraints, commitments to UHC, the low efficiency of services and the political challenges in optimizing the service delivery network.

Applying knowledge in development of actionable reform plans

During the course, participants were asked to develop a reform plan for their respective countries. The work started with a detailed analysis of the local situation, which was then used to define areas of possible intervention. Participants used the framework of health financing functions to develop reform plans, instead of relying on the popular model-based approach for future reforms.

At the end of the course, each country had a chance to present its plans and to receive feedback from trainers and other participants.

Feedback from participants

“I was expecting that the course will be focused on health financing, but it covers wider range of issues: health benefits for population, quality of care, improved access to medicines, other reforms to support UHC. During this course I understood the dangers of fragmentation in health care, starting from one in financing, but also in service delivery,” said Timur Sultangaziyev, Director of the Project Management Department, Ministry of Health, Kazakhstan.

“It was very important for me to both get new knowledge and to have an opportunity to hear experience from other countries of our region. We are implementing health reforms in Armenia, and this course gave me very good insights on strategic purchasing and selective contracting,” reported Ani Harutyunyan, Head of the Financial-Economic Department, Ministry of Health, Armenia.

“My expectation was to explore options for increasing quality of care with means of health financing reform. I received information I needed and will apply it for implementation of strategic purchasing of health services in my country, which will start in 2018,” shared Olga Andrejevska, Department Director, National Health Service, Latvia.

“We are moving towards UHC in Ukraine. On this journey I see that it is very important for us to develop benefit design in Ukraine, and thus make it clear to patients what is covered by public funds. For us it was also very important to understand how expenditures are planned, how purchasing works, how to transit from simple financing of facilities to purchasing of services. Thanks to this course I understood what we need to do in our region. We definitely need more courses like this one in Ukraine,” said Victor Lysak, Director of the Health Department, Poltava Regional State Administration, Ukraine.